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What Makes Singapore’s Health Care So Cheap?
- baybal2 9y agoI spent 2 years of my life in Singapore as an excange student 10 years ago. >What Makes Singapore’s Health Care So Cheap? I think they missed the most obvious reason: China Singapore's public health system does not shy away from purchasing a lion share of pharmaceuticals, disposables, and medical equipment from China. And about C class, the 'conveyorised' healthcare is one of biggest cost cavers when Singapore's medical specialist salary is approaching Western levels. Doctors focus on throughput. The goal is to fix the person and kick him out of hospital as fast as possible, and not to make everything possible to extend his stay as '5 star hotel hospitals' do in USA
- maxxxxx 9y ago"The goal is to fix the person and kick him out of hospital as fast as possible, and not to make everything possible to extend his stay as '5 star hotel hospitals' do in USA" From my experience they are happy to kick you out right after surgery while still charging a ton of money. My girlfriend just had a surgery. Took 5 hours from entering the building to leaving the building. Cost was 40k. This is just for the surgery center. The doctors were extra.
- bogomipz 9y ago>"I spent 2 years of my life in Singapore as an exchange student 10 years ago" I'm sorry but how does spending two years there as an exchange student a decade ago add any weight to your opinion? As an exchange student weren't you still part of your parents insurance? Also do you think nothing has changed in 10 years?
- yardie 9y agoI think no one but a few moderately rich Canadians consider US hospitals 5-star. In my experience, most US hospitals, as soon as they find out you have a little money try to do services add. The ambulance ride, nurse, specialist, radiologist, MRI, bed, CATV, telephone, and meals all add up on that bill. And once they've exhausted your insurance or personal finances then they kick you out.
- DaiPlusPlus 9y agoI live in Western Washington and Swedish Medical operates a number of hospitals in the area and they are very, very nice and plush on the inside. Their Issaquah hospital has carved stone entrances to the operating theatres - it's crazy: https://www.daycpm.com/swedish-issaquah-medical-campus/ https://www.daycpm.com/swedish-issaquah-medical-campus/ https://www.alights.com/swedish-issaquah-medical-center-0 https://www.alights.com/swedish-issaquah-medical-center-0 Google Image Search for "Swedish Seattle birthing" and the childbirth suites resemble 5-star hotel rooms, complete with in-room hot spa.
- mywittyname 9y agoHe's referring to the fact that insurance companies have shifted towards a system where "patient satisfaction" is a key driver of payment. This has caused a bit of a crisis in hospitals as executives push BS programs intended to improve these scores and they often come at the expense of actual care. It's becoming a huge issue in US hospitals
- moduspol 9y agoIt's not too surprising. The patient doesn't care what's being charged! We'd see the same thing in other industries if market interference led to the customer not being price sensitive. Like higher ed.
- mywittyname 9y agoMy understanding is that it's really just one more way insurance companies try to avoid paying for hospital bills. My partner works in revenue recovery for a regional hospital and it's staggering how awful insurance companies are. I've heard many stories where waiting for insurance authorizations would have literally cost people their lives, but the insurance has grounds to refuse payment without it, so the hospital ends up eating the entire cost of the person's care. The system is so incredibly fucked up. Far beyond what most people think. That being said, maternity wards are apparently the college campus of the hospital world, which is why you see so many of them being built in rich areas. They are insanely profitable.
- disordinary 9y agoMost of the world does this, here in NZ the government bulk buys most of our medication through an entity known as Pharmac. They often buy off brand medication from India for instance instead of the branded equivalents. One of the best things about the US removing itself from the TPPA is the fact that one of their conditions of entry was the fact that Pharmac would have had to buy branded pharmaceuticals from US companies rather than the Generics that we usually get which would have increased the cost that the country pays for pharmaceuticals massively.
- philliphaydon 9y agoHaving lived in singapore 6 years and being in hospital 3 times with total bills amounting to around $75,000. No
- ausjke 9y agoBefore I dive in, I want to say "size matters". Singapore is the size of a city in US, whatever works for them does not apply to US as a whole.
- kelnos 9y agoI'm very tired of this argument that alway seems to get trotted out in an attempt to shut down discussion. I'd love to see a US state try to do some drastic health care reforms. CA has toyed with single-payer options, though it's hampered funding-wise by the federal government, and the fact that, despite popular appearances, CA has a large segment of conservative voters. Singapore and, say, South Carolina, have similar populations, so you'd expect to be able to implement Singapore-style healthcare on a state level if your only objection is population. In reality, though, consensus-building and lobbying dollars tend to be the biggest obstacles to US-wide reform.
- dragonwriter 9y ago> Singapore is the size of a city in US Well, a city, in that it's significantly larger than any city in the US other than NYC.
- bogomipz 9y agoIf you count the city limits proper that would be true. If you count the agglomeration or greater city area which is what you are doing by saying all of Singapore then no, not by a long shot: https://en.wikipedia.org/wiki/List_of_the_largest_urban_agglomerations_in_North_America https://en.wikipedia.org/wiki/List_of_the_largest_urban_aggl...
- dragonwriter 9y ago> If you count the city limits proper that would be true. If you count the agglomeration or greater city area which is what you are doing by saying all of Singapore then no, not by a long shot: Yes, if you said “Singapore is of similar size to a large metropolitan area in the U.S.”, rather than “...a city...”, then, yes, the comparison would be to a category where Singapore's population would be reasonably typical, rather than just shy of the biggest. But when you say “city”, it doesn't communicate something bigger than a city just because the thing you are comparing to a city is, itself, not just a city.
- crdoconnor 9y agoThey somehow failed to mention price controls, except obliquely. That's impressive.
- fiokoden 9y agoThe key idea I see here is that instead of dumping money into insurers, you have your own government mandated "health savings account". People would be far less likely to overuse health services if they felt they were paying personally. That's a powerful idea.
- m1sta_ 9y agoIs there any good data on health service overuse?
- fiokoden 9y agoMy understanding is that overuse is one of the primary reasons health spending is so high in most countries. No data to back it up, might be wrong. I can tell you I absolutely loathe pouring money into health insurers to prop up an overused and wasteful system. I'd much rather something like this personal account idea.
- morley 9y agoFurther into the article, they also mention that there are a lot of government regulations about proportions of high-class beds to lower-class ones, needing approval to buy expensive medical equipment, and the number of physicians. From the end of the article: > [American] Conservatives will point to the Medisave accounts and the emphasis on individual contributions, but ignore the heavy government involvement and regulation. Liberals will point to the public’s ability to hold down costs and achieve quality, but ignore the class system or the system’s reliance on individual decision-making.
- JamesBarney 9y agoThe article specifically says this is not the case, and that it actually increased health care spending. Here's the quote. In a 1995 paper in Health Affairs, William Hsiao looked at how health spending fared in Singapore before and after the introduction of Medisave. He found that health care spending increased after the introduction of increased cost-sharing, which is not what most proponents of such changes would expect.
- kuwze 9y agoWhy is there never a comparison to Japan? They are 1/2 the size of the USA, have a privatized health system, and it's pretty damn awesome. They also have price controls which make things a lot easier to comprehend.
- doh 9y agoSpot on. Noah Smith made the comparison couple of months ago [0]. [0] https://www.bloomberg.com/view/articles/2017-09-19/want-a-better-health-care-system-check-out-japan https://www.bloomberg.com/view/articles/2017-09-19/want-a-be...
- em3rgent0rdr 9y agosounds like that isn't fully privatised but is rather a hybrid.
- DaiPlusPlus 9y agoIsn't it redundant? I understand Japan's system is somewhere in-between Switzerland and Singapore's.
- erentz 9y agoIt seems like Japans system would just be Medicare, as it is today, for all. That is just take out the line that limits Medicare to those over 65. Medicare still allows for private insurance to cover the gap between what Medicare pays and covers. As I understand it Bernie’s plan is a bit more than this and would expand Medicare to be a full single player plan. At this point though it seems we have more than enough comparisons and data telling us to do something. They’re all going to be nearly night and day in terms of comparison to what we have currently.
- dv_dt 9y agoI think the essential ingredients for controlled healthcare costs is a) the principle of universal healthcare b) government control of procedure and drug costs. No one is as expensive as the US per capita for healthcare. All the other nations beating us have wildly mixed healthcare delivery systems from full public to hybrid public/private - the hybrids are all administered differently. The characteristic they all seem to share in common is those two features. Even the worst of the modern nations systems beats the US cost and universality of coverage, and quality, by a large margin. Japan seems to have a mixed private/public insurance system, but has government control of the fee schedule. https://en.wikipedia.org/wiki/Health_care_system_in_Japan https://en.wikipedia.org/wiki/Health_care_system_in_Japan "The government has well controlled cost over decades by using the nationally uniform fee schedule for reimbursement." "Fees for all health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country. If physicians attempt to game the system by ordering more procedures to generate income, the government may lower the fees for those procedures at the next round of fee setting" "Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply)." For Singapore: https://en.wikipedia.org/wiki/Healthcare_in_Singapore https://en.wikipedia.org/wiki/Healthcare_in_Singapore "Singapore has a non-modified universal healthcare system where the government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies, and price controls." Notice the "price controls"... It really doesn't seem to matter strongly exactly what mix of private/public does the actual administration. To capture first order cost savings better than what the US pays you need to control the fees.
- Lxr 9y agoFrom my observation living in Singapore lifestyle is an important factor. People are generally active and there seems to be little obesity. Among young guys at least, national service and the associated mandatory fitness requirements seem to play a part in setting long term habits early.
- inferiorhuman 9y agoSee also: Trim and Fit. Obesity is a thing in Singapore.
- seanmcdirmid 9y agoYa, isn't it really hot and humid there? That would make exercise a bit harder.
- eesmith 9y agoSingapore has the nickname "The Air-conditioned Nation". More to the point, the climate hasn't changed but the percentage of obese people there, like in most countries, is increasing. You therefore can't attribute that recent increase to heat and humidity.
- seanmcdirmid 9y agoYa, that makes sense. Also, if it's like southern china, people are probably pretty active outside at night when its cooler (e.g. Night square dancing, night markets, etc...). Rising obesity rates can be related to the weather even if it hasn't changed if there is pressure on lifestyle from other areas (e.g. Work/life balance). E.g. People in the south USA are not increasingly obese even though the weather stays the same, life style pressure plus hot and humid climate combine to create the problem; climate makes the problem more difficult to fix once it appears.
- inferiorhuman 9y agoFrom my experience, it's still hot as balls at night. The only deliberate activity I did outside in SG at any time of day was to go find air conditioning inside. Of course I'm American, not Singaporean.
- hellofunk 9y agoSingapore's medical community scares me a little bit. Despite having implanted metal in my body, an orthopedic surgeon wanted to give me an MRI anyway. It's completely absurd, I got a second opinion and fortunately found a doctor who agreed that would be extremely dangerous. It's true that the first doctor did not cost that much; it's also true I got what I paid for.
- sanswork 9y agoA lot of metal implants(most?) are safe for MRIs so your original doctor who did the implant and was aware of its composition was possibly correct and your second one was possibly just happy to agree with you.
- hellofunk 9y agoDude, that is most definitely not true. It is true that implants being done today often contain metal that could be safe for future MRIs, but implants from more than just a few years ago are generally very dangerous. In my case my implant is not at all safe, and the surgeon absolutely should've known that. There is a general sense of ignorance among lots of medical community there for some reason.
- sanswork 9y agoInteresting what is your implant made of that it is definitely not safe?
- hellofunk 9y agoIt's a standard pacemaker. There's the device itself and then the wires to go to the heart. Any surgeon with half a brain should know you don't go anywhere close to an MRI with that. And for all of his misguided advice that could've threatened my life, I still had to pay him of course. He never did any research or checking on my particular model to even see if there was a danger or not. Turns out, the danger is extreme.
- hellofunk 9y agoIncidentally, almost half of Singapore's population are foreigners. And if you are not a citizen, you do not get proper health insurance there that covers things like pre-existing conditions. This is in stark contrast to many other nations in the world where legal residents, whether citizens or not, get the same care and treatment.
- baybal2 9y agoBlue card (edit: permanent resident card) holders have full coverage, and have to pay for it fully
- hellofunk 9y agoIm not sure what Blue card means. Do you mean PR? If so that's basically citizenship. I'm talking about all the people who are there for work.
- int_19h 9y agoBy the same token, "in stark contrast to many other nations in the world where legal residents, whether citizens or not, get the same care and treatment" above also generally does not apply to temporary workers, but does apply to permanent residents, in those other nations.
- woolvalley 9y agoIn canada if your a canadian resident (not a tourist basically) you get healthcare. Many provinces also have a 3 month residency requirement, but some don't even have that. On top of that, uninsured costs of healthcare are still significantly cheaper.
- hellofunk 9y agoEurope grants you those rights even for a temporary work visa.
- narrator 9y agoA health minister who makes $1.3 million dollars a year so he is bribed directly by the people to represent their interests and not by health care lobbyists who are just looking for ways to increase costs and make more money.
- ValentineC 9y agoI think Singapore's cabinet ministers are overpaid for the "value" they offer. The previous health minister (who's currently the transport minister) is a joke among Singaporeans, since he took credit for managing the SARS incident that happened before his stint as health minister [1], and couldn't manage to fix rising house prices or the failing public transport system in his subsequent portfolios. [1] https://en.wikipedia.org/wiki/Khaw_Boon_Wan#Minister_for_Health https://en.wikipedia.org/wiki/Khaw_Boon_Wan#Minister_for_Hea...
- jnaina 9y agoSingaporean here. 'Failing" Public Transport System? Sure the SMRT has issues, but it is still one of the best run train systems in the world. Second only to HK MTR. Having used the BART, UK and NY Train services, the Singapore MRT system is far more cheaper and efficient. Not to mention cleaner, safer , etc. Yes, it is fashionable to criticize the PAP fatcats. But having lived in an assortment of first world and other Asian countries, Singapore is haven, albeit a "Gated Community" with a benevolent and paternalistic government. Given the chaos I seen in some of the late-stage-capitlisitic democracies, Singapore gives you safety and stability, at the expense of giving away some freedom and rights. Price that I'm willing to pay and I'm sure the majority of Singaporeans also do. And yes, I'm OK to fund and support the PAP "fatcats" as long as they deliver the goods. Their salary is peanuts compared to the waste, corruption and chaos that I see in the regional Asian countries due to corrupt kakistocracies in power. Case in point, up north from Singapore.
- tuna-piano 9y agoThe article touches on this: "But when hospitals competed, they did so by... paying more for doctors..." "Singapore heavily regulates the number of physicians, and it has some control over salaries as well." What makes price controls for doctors wages different than failures with price controls in other industries?
- adventured 9y ago> What makes price controls for doctors wages different than failures with price controls in other industries? It's not different conceptually, there are numerous negative consequences for the market and the doctors. It's different in terms of what's morally tolerated on the basis that healthcare is now viewed, very widely, as a right. Even in the US that's increasingly becoming the public view, which is why the Republicans (with the Presidency + both houses of Congress) couldn't get close to fully removing the ACA (eg the protections around existing conditions is overwhelmingly popular even for the majority of Republican voters). If healthcare is a right, then the people working in healthcare are what exactly? You have a right to N healthcare, that must be provided by the labor of someone else. There are two common answers to that, based on what one believes ideologically: those workers are either economic slaves, or they're knowingly accepting a social contract of sorts by choosing to be in the field.
- tim333 9y agoPrice caps on most things produce shortages. Doctors on the other hand are generally not that money motivated - I doubt many would drop out of medical college because the salary was $80k rather than $120k say. Though there are limits - I know some people drop out of the UK NHS.
- hitekker 9y agoPersonal anecdote: My Singaporean Uncle got stage IV nose-cancer two years ago. He has two kids, a stay-at-home wife and a job that pays only middle income. After a year of constant, weekly treatment by an assortment of doctors, he went into remission and paid in total less than one thousand dollars. My Singaporean ex-girlfriend had systemic organ issues over her life, that have alternately caused her seizures and blackouts. She was hospitalized for years at a time. Again, middle income family, with three kids and a stay-at-home-wife. Her family paid virtually nothing for 15+ years of treatment, and then the government paid for her university. Full-ride. Oh and they also paid her directly to attend classes. About S$1500 per semester, last time I checked. I have so many other great stories about my mother's country. For now, my sentiment is that Singapore's society, government and people, on balance, cares about each other. Not a power-hungry "all glory to the nation" care, or a brainless "let's give everyone everything for free" care, but a "these people are people like you and I. If I put on their shoes, how would I like to be treated?" care. In the United States, that basic, human empathy is in question.
- MadSudaca 9y agoIt seems to me that it's unfair to compare a relatively small, new and homogeneous country such as Singapore with the states, and come to the conclusion that the USA lacks human empathy.
- mullen 9y ago> relatively small, new and homogeneous Not only is two of these completely wrong, what does that have to do with anything anyways? The United States is 50 small countries in one big country, there is no reason why a Singapore system could not be done here. The age of and diversity of a country have nothing to do with its healthcare system.
- MadSudaca 9y ago> there is no reason why a Singapore system could not be done here. I'm not saying it's impossible for the US to have a better healthcare system, I'm saying that looking at what Singapour has and then concluding that people in the states lack empathy is not only unfair, but also lacking in perspective. > The United States is 50 small countries in one big country Not only are each of the states bigger than Singapour, but they're different to each other and at the same time they're not completely independent of each other. > The age of and diversity of a country have nothing to do with its healthcare system. A system that has been in place for a longer period of time, tends to become larger, more complex and harder to change. Moreover, a society that is more heterogeneous will have a harder time agreeing on an issue. Also in a democratic country, the larger the population, the more people you'll have to convince in order to change the status quo.
- Iv 9y agoLow corruption. Competent leadership. Efficient administration. With these, any healthcare system will work well.
- tormeh 9y agoThat's like saying a company will always be successful as long as it executes well. Good execution is absolutely necessary, and can compensate for mediocre strategy, but it can't fix a truly broken model.
- tormeh 9y agoThe YouTube channel Health Care Triage has a series on different countries health care systems. Super interesting how different the systems are.
- ygdrasil 9y agoHaving worked in both Singapore and US, I find the key difference in healthcare and other societal issues is the ideology. US: left or right, liberal or conservative. Singapore: whatever works. After all Singapore is one of the few living city states and less than 60 years old. Running a 200+ year old huge nation state means complexity and challenges on an exponentially different scale.
- CryptoPunk 9y ago>>But when hospitals competed, they did so by buying new technology, offering expensive services, paying more for doctors, decreasing services to lower-class wards, and focusing more on A-class wards. This led to increased spending. >>In other words, Singapore discovered that, as we’ve seen many times before, the market sometimes fails in health care. Why is increased spending on buying new technology deemed a failure? Maybe the optimal healthcare spending level is far higher than what's spent now.
- peteretep 9y agoComparison with the NHS seems a little unfair given relative population densities. > what makes it beloved among many > conservative policy analysts, is its > reliance on health savings accounts. > All workers are mandated to put a > decent percentage of their earnings > into savings for the future If you tried this in America you'd have anti-Communism riots on the street with Ann Coulter and Sarah Palin talking about how FEMA were using the money to set up death camps before taking their guns.
- eru 9y ago> Comparison with the NHS seems a little unfair given relative population densities. London needs to become a city state, then. Why subsidise those hillbillies?
- tim333 9y agoNot that it'd happen but it would be an interesting experiment if you could try changing to the Singapore system in some part of the US. Say Hawaii or Puerto Rico. It would be an upheaval but at ~1/3 the cost and longer life expectancy it could be worth trying. Assuming the locals were up for it.
- korginator 9y agoIt's doable because Singapore is a small city-state, easily regulated, strongly controlled and managed. The largest hospitals are public, and the smaller ones private, i.e., the government has positioned itself to be the main healthcare provider, ergo, their strong ability to manage and control healthcare costs is all but guaranteed. In doing so, they have blocked profiteering, collusion and exploitation by vested interests, but this can be challenging to impossible to achieve in other countries due to the obvious reasons.